Jones Erika M, Portnoy Jay M
Section of Allegy, Asthma & Immunology, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Curr Allergy Asthma Rep. 2003 Nov;3(6):484-90. doi: 10.1007/s11882-003-0059-9.
Despite an abundance of scientific evidence supporting the use of guidelines, adherence to asthma practice guidelines by physicians generally is low, regardless of provider and patient characteristics. As a result, scientific information, obtained with great effort and at huge expense, is not being translated into clinical practice. To remedy this, we developed a disease management program that emphasizes alteration of provider behavior using operant conditioning. We did this by placing asthma educators in private offices for up to 8 weeks. The educators used a combination of problem-based learning, role modeling, and operant conditioning with positive reinforcement to affect behavior change. As a result of these behavior changes, by the end of 8 weeks the cost to treat asthma patients decreased, despite an increase in the cost of medications. We concluded that behavior-oriented programs targeted at provider offices can lead to improved asthma care while reducing costs.
尽管有大量科学证据支持指南的使用,但无论医疗服务提供者和患者的特征如何,医生对哮喘实践指南的遵循程度总体较低。因此,通过巨大努力和高昂成本获得的科学信息并未转化为临床实践。为了纠正这一情况,我们制定了一项疾病管理计划,该计划强调利用操作性条件反射改变医疗服务提供者的行为。我们通过在私人诊所安置哮喘教育工作者长达8周来实现这一点。教育工作者采用基于问题的学习、行为示范以及带有积极强化的操作性条件反射相结合的方法来影响行为改变。由于这些行为改变,到8周结束时,尽管药物成本有所增加,但治疗哮喘患者的成本却降低了。我们得出结论,针对医疗服务提供者诊所的以行为为导向的项目可以在降低成本的同时改善哮喘护理。